NHS Trust: Pathology

This NHS Trust provides a service to a wide range of people across a great rural area, with a higher than national average of patients being over the age of 65. As the number of diseases and illnesses are increasing The Trust is struggling to cope with the demand of the patients and believe the service they provide could be improved to create better efficiency and less waste. By initially concentrating upon improving the Pathology Department the Trust believe they can make a difference to not only how the specimens they receive are processed, but to also reduce their turnaround times, which will greatly impact the swiftness of how inpatients are discharged from wards after their stay. To improve such an area in a step-by-step manner will also allow the hospital to work towards attaining a foundation status, which requires them to save £8m over the next two years.

Initial Observations

• 100’s of specimens would be delivered via the 4 different ‘runs’ at around 3:30pm, causing a peak in work, everyday
• The ‘peak and troughs’ of the delivery times led to staff ‘fire-fighting’ to process the specimens before 5pm
• Specimens sent in an emergency were not always treated with a high priority, especially after 3:30pm
• Poor layout and design of the Specimen Reception Area (SRA), creating unnecessary waste in motion and transportation of specimens
• No work instructions, or standardised procedures to follow after initial training was provided
• Poor housekeeping, bulk buying and subsequent storage
• Patient details were booked in twice by both Haematology and Biochemistry respectively
• Some managers and their departments were positive about the Lean initiative being undertaken, whereas others perceived it as a threat to their working practices
• Poor use of resources and machines, with sub-optimal utilisation of each

Improvement Strategy

• Improve the transportation and the delivery of the samples arriving to Pathology
• Create a sustainable area by implementing Lean tools and techniques within the SRA to demonstrate their positive impact

Lean Deployment

• Firstly address the transport issues, whereby the four runs were analysed to see if they could be broken into better routes and that the collection time of samples could be staggered to prevent the rush at 3:30pm
• Both the biochemistry and haematology processes were mapped to highlight both the process execution and the cycle times, from here waste such as motion, waiting etc was noted and corrected to improve process efficiency
• With the support of the medical staff, the SRA layout was redesigned to create a better flow of the samples coming into the area, how they were processed and subsequently taken out
• Charts were created to illustrate the best optimisation of how both people and equipment (namely centrifuges and analysers) can be utilised together, whereby waits and delays were wither removed, or reduced to a minimum
• 5s and visual management was employed around the SRA, which helped to locate items and equipment far quicker than before, whilst also allowing quick visual management
• Where problems had occurred, a full analysis was made and steps drawn up to illustrate how the problem could be contained and countermeasured to prevent such an occurrence again
• Staff were asked to detail any issues they had, regarding their processes, the facilities, the equipment etc. all such issues were noted and grouped into categories. They were then assigned an owner who would take responsibility for addressing the issue, within a certain target date
• Standardised procedures were created, and placed by equipment to ensure staff followed such procedures to ensure best practice